RESUMEN
Metastatic lesions of non-urological malignancies to the bladder are rare and often secondary to spread from a contiguous site. Distant metastasis to the bladder is even more uncommon. There are less than 10 previously described cases of metastatic pulmonary adenocarcinoma to the bladder in the literature over the past 20 years. In this report, we describe a 73-year-old African American gentleman with a history of prostate cancer who presented to the urology department with gross hematuria. Follow up imaging suggested possible neoplastic changes to the bladder. Biopsy and histochemical staining revealed poorly differentiated adenocarcinoma of pulmonary origin.
RESUMEN
Cellular angiofibroma (CAF) is a rare, benign mesenchymal tumor found usually in the female vulvar and male inguinoscrotal regions. A 56-year-old Caucasian gentleman presented with left sided scrotal swelling after masturbating. The swelling was thought to be an inguinal hernia, although was found to be a soft tissue tumor upon dedicated cross-sectional imaging. Pathological evaluation of the mass revealed it to be a cellular angiofibroma. Diagnosis of CAF can only be made after resection and proper immunohistological staining. Ultrasonography and MRI are preferred for detailed soft tissue characterization. After surgical resection, follow-up imaging is recommended given potential risk of malignancy.
RESUMEN
OBJECTIVE: To determine if reported incidence rates of hemorrhagic cystitis after radiation therapy for prostate cancer are accurate, to investigate the effect of different radiation modalities on the development of hemorrhagic cystitis and to assess its morbidity and treatment. MATERIALS AND METHODS: A retrospective chart review was completed of 709 patients at 2 Detroit Medical Center hospitals who underwent radiation therapy for prostate cancer between January 2000 and September 2015. In patients who developed hemorrhagic cystitis, we analyzed the incidence, radiation modality, morbidity, treatment, and complications. RESULTS: The incidence rate of hemorrhagic cystitis after radiation for prostate cancer was 11.1%. There was no significant difference between external beam and intensity-modulated radiation therapy and the development of hemorrhagic cystitis (P = .18). Patients developed hemorrhagic cystitis an average of 79.1 months (4-230 months) after radiation. The average number of admissions was 2.5 (1-9) with an average length of stay of 7.6 days (1-42 days). Fifty-two percent of patients required blood transfusion with an average of 4.3 units transfused per patient (1-33U). The most common treatment was cystoscopy with fulguration/clot evacuation in 86% of patients. Complications included urinary tract infection, acute kidney injury, urosepsis, and even death. CONCLUSION: The incidence of hemorrhagic cystitis following radiation therapy for prostate cancer is under-reported in the literature. Hemorrhagic cystitis is associated with high morbidity and complications for patients, requiring multiple hospitalizations, blood transfusions, and procedures. Advances in radiation have not significantly reduced the risk of developing hemorrhagic cystitis.
Asunto(s)
Cistitis/epidemiología , Cistitis/etiología , Hemorragia/epidemiología , Hemorragia/etiología , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/complicaciones , Traumatismos por Radiación/epidemiología , Anciano , Anciano de 80 o más Años , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Morbilidad , Estudios RetrospectivosRESUMEN
Few studies have examined the roles of dorsal penile nerve block (DPNB) and penile ring block (PRB) in surgery of inflatable penile prosthesis (IPP) placement. We sought to compare the postoperative pain outcomes of two different medications used in DPNB plus PRB. We thus carried out a prospective study of patients with erectile dysfunction who underwent "de novo" IPP placement between January 2013 and June 2013. Patients were divided to one of three groups: 1-DPNB plus PRB with bupivacaine injection; 2-DPNB plus PRB with ropivacaine injection and, 3-Control group without DPNB or PRB injection. Postoperative pain score and pain medication usage were recorded 2 h postoperatively, and every 24 h, for a week. The Visual Analog Scale (VAS) was used as pain scale measurement. A total of 131 patients were included in this study: 40 to bupivacaine, 47 to ropivacaine, and the rest were controls. Two hours postoperatively, mean VAS was significantly different (p < 0.0001) between medicated patients and the control group, however, no significant differences were observed between medication groups. Mean VAS was not significantly different among the groups from post-surgical day 2 thru 7. In conclusion, DPNB plus PRB during IPP provided effective analgesia in the immediate post-operative recovery.
Asunto(s)
Amidas/uso terapéutico , Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Implantación de Pene/métodos , Anciano , Anciano de 80 o más Años , Anestesia Local/métodos , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Implantación de Pene/efectos adversos , Prótesis de Pene , Estudios Prospectivos , Ropivacaína , Resultado del TratamientoRESUMEN
Mycoplasma canis can infect many mammalian hosts but is best known as a commensal or opportunistic pathogen of dogs. The unexpected presence of M. canis in brains of dogs with idiopathic meningoencephalitis prompted new in vitro studies to help fill the void of basic knowledge about the organism's candidate virulence factors, the host responses that it elicits, and its potential roles in pathogenesis. Secretion of reactive oxygen species and sialidase varied quantitatively (P < 0.01) among strains of M. canis isolated from canine brain tissue or mucosal surfaces. All strains colonized the surface of canine MDCK epithelial and DH82 histiocyte cells and murine C8-D1A astrocytes. Transit through MDCK and DH82 cells was demonstrated by gentamicin protection assays and three-dimensional immunofluorescence imaging. Strains further varied (P < 0.01) in the extents to which they influenced the secretion of tumor necrosis factor alpha (TNF-α) and the neuroendocrine regulatory peptide endothelin-1 by DH82 cells. Inoculation with M. canis also decreased major histocompatibility complex class II (MHC-II) antigen expression by DH82 cells (P < 0.01), while secretion of gamma interferon (IFN-γ), interleukin-6 (IL-6), interleukin-10 (IL-10), and complement factor H was unaffected. The basis for differences in the responses elicited by these strains was not obvious in their genome sequences. No acute cytopathic effects on any homogeneous cell line, or consistent patterns of M. canis polyvalent antigen distribution in canine meningoencephalitis case brain tissues, were apparent. Thus, while it is not likely a primary neuropathogen, M. canis has the capacity to influence meningoencephalitis through complex interactions within the multicellular and neurochemical in vivo milieu.